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学术论著中国医学装备2019年12月第16卷第12期 China Medical Equipment 2019 December Vol.16 No.12螺旋断层MVCT在鼻咽癌自适应放射治疗中的剂量学研究倪千喜① 朱 俊② 庞金猛①[文章编号] 1672-8270(2019)12-0020-04 [中图分类号] R739.6 R814.2 [文献标识码] A*[摘要] 目的：研究螺旋断层放射治疗系统(TOMO)兆伏级CT(MVCT)成像(TOMO-MVCT)在鼻咽癌自适应放射治疗(ART)中直接用于剂量计算的可行性。方法：采用数表法随机选取20例行鼻咽癌TOMO治疗的患者，采集患者首次治疗的MVCT图像，在TOMO治疗计划系统中，将采集到的MVCT图像与放射治疗计划的千伏级CT(kVCT)图像进行融合配准。将治疗计划植入MVCT图像中，选取相应MVCT电子密度曲线进行剂量计算。比较分析基于MVCT和kVCT图像计算的靶区和危及器官(OAR)剂量分布差异。结果：MVCT相对于kVCT图像计算的肿瘤靶区(GTV)和计划靶区(PTV)剂量D95分布相对误差分别为(0.65±0.58)%和(0.66±0.73)%；OAR脑干、脊髓、左晶体、右晶体、左眼球、右眼球、左视神经、右视神经和垂体剂量Dmax分别为(0.70±1.16)%、(0.31±2.26)%、(-0.19±1.32)%、(-0.33±1.96)%、(-0.15±2.34)%、(0.37±1.32)%、(0.40±0.72)%、(0.29±0.55)%和(0.53±0.70)%；左腮腺和右腮腺的D50分别为(0.65±1.11)%和(0.26±0.86)%。结论：基于TOMO-MVCT成像与kVCT图像的剂量计算差异＜2%。TOMO-MVCT图像可直接用于鼻咽癌ART的剂量计算。[关键词] 自适应放射治疗；鼻咽癌；螺旋断层兆伏级CT；剂量学；相对误差DOI: 10.3969/.1672-8270.2019.12.006Dosimetric study of TOMO-MVCT in ART of nasopharyngeal carcinoma/NI Qian-xi, ZHU Jun, PANG Jin-meng//China Medical Equipment,2019,16(12):20-23.[Abstract]
Objective: To investigate the feasibility of direct application of tomotherapy megavoltage computed
tomography (TOMO-MVCT) in dose calculation of adaptive radiation therapy (ART) of nasopharyngeal carcinoma.
Methods: Twenty patients with nasopharyngeal carcinoma who underwent the treatment of TOMO were randomly
selected by number table method. The MVCT images of patients who received the first treatment were collected. In the
TOMO treatment planning system, the MVCT images were fused and mated with the kilovoltage CT (kVCT) images
of radiotherapy plan. The treatment plan was implanted into the MVCT image, and the MVCT electron density curve
was selected to implement dose calculation. The differences of dose distribution of target volume and organ at risk
(OAR) based on the calculations of MVCT and kVCT images were compared and analyzed respectively.
Results: The
relative error of D95 of gross tumor volume (GTV) and planning target volume (PTV) between MVCT and KVCT image
were (0.65±0.58)% and (0.66±0.73)%, respectively. The relative errors of Dmax of OARs, included brain stem, spinal
cord, left lens, right lens, left eyeball, right eyeball, left optic nerve, right optic nerve and pituitary, between MVCT
and kVCT image was (0.70±1.16)%, (0.31±2.26)%, (-0.19±1.32)%, (-0.33±1.96)%, (-0.15±2.34)%, (0.37±1.32)%,
(0.40±0.72)%, (0.29±0.55)%, (0.53±0.70)%, respectively. The relative errors of D50 of left parotid and right parotid
between MVCT and KVCT image were (0.65±1.11)% and (0.26±0.86)%, respectively.
Conclusion: The difference of
dose calculation based on TOMO-MVCT and kVCT images is less than 2%. The TOMO-MVCT images can be directly
applied in dose calculation of adaptive radiation therapy of nasopharyngeal carcinoma.[Key words] Adaptive radiation therapy; Nasopharyngeal carcinoma; Tomotherapy megavoltage computed tomography
(MVCT); Dosimetry; Relative error[First-author’s address] Department of Radiotherapy, Hunan Cancer Hospital/The Affiliated Cancer Hospital
of Xiangya School of Medicine, Central South University, Hunan Provincial Key Laboratory of Radiotherapy and
Translational Medicine of Cancer, Changsha 410013, China.在放射治疗过程中，由于肿瘤靶区体积消退、患at risk，OAR)的相互位置关系发生变化，在人体内的放射治疗剂量分布也会随之发生改变。因此，自适应放射治疗(adaptive radiation therapy，ART)技术[1-3]应用越来越广泛。鼻咽癌目前以调强放射治疗(intensity modulated radiation therapy，IMRT)为主要治疗方法，自适应放射治疗应用优势显著[4-5]。由于螺旋断层放射治疗系统(tomotherapy，(TOMO-MVCT)与治疗同源，成像精度高，TOMO-MVCT在自适应放射治疗中扮演着重要角色。本研究通过比较TOMO-MVCT与放射治疗计划常规采用的千伏级CT(kilovoltage CT，kVCT)在放射治疗剂量计算方面的差异，分析TOMO-MVCT在鼻咽癌ART中的应用价值。者体重变化等原因，致使肿瘤与周围危及器官(organ TOMO)兆伏级(megavoltage CT，MVCT)成像*基金项目：湖南省自然科学基金青年基金(2017JJ3196)“自适应放疗数据库模型指导下非小细胞肺癌个体化治疗的研究”①湖南省肿瘤医院中南大学湘雅医学院附属肿瘤医院放疗科 肿瘤放射治疗转化医学湖南省重点实验室 湖南 长沙 410013
②湖南省肿瘤医院中南大学湘雅医学院附属肿瘤医院监管办 湖南 长沙 410013作者简介：倪千喜，男，(1981- )，硕士，高级工程师，从事放射物理研究工作。20 ZHONGGUOYIXUEZHUANGBEI
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